CDC seeks data on nondrug prevention of pandemic flu

Oct 13, 2006 (CIDRAP News) – The Centers for Disease Control and Prevention (CDC) plans to fund eight studies on whether simple measures such as handwashing, "cough etiquette," and face masks could help limit the extent of the next influenza pandemic.

The CDC announced this week it would provide a total of $5.2 million to research institutions, some outside the United States, to assess nonpharmaceutical measures for battling pandemic flu.

The announcement comes amid a wide-ranging CDC effort to come up with specific guidelines on the use of such prevention steps by the end of this year, according to Dr. Martin Cetron, director of the agency's Division of Global Migration and Quarantine.

Nonpharmaceutical measures may serve as a first line of defense in a pandemic, since it could take several months to develop an effective vaccine, the CDC said in a news release. But officials said there is little scientific evidence about the effectiveness and potential impact of such steps.

"Our challenge now is to determine which community-level measures will work best to limit the spread of infection," CDC Director Dr. Julie Gerberding commented in the announcement.

Besides handwashing, cough etiquette, and masks, community prevention measures include "social distancing" steps such as closing schools and workplaces and canceling large gatherings. Other steps include voluntary isolation of patients and voluntary quarantine of their household contacts, according to the CDC.

Initial results from some of the studies should be available within about a year, Cetron told CIDRAP News yesterday. Several of the studies will involve following groups of people through the upcoming flu season, he said.

The studies and their principal investigators are as follows:

Effectiveness of Selective Non-Pharmaceutical Interventions in Reducing Influenza-Like Illness Among University Students, Tomas Aragon, MD, University of California, Berkeley

Stopping Upper Respiratory Infections and Influenza in the Family: the Stuffy Trial, Elaine Larson, PhD, Columbia University, New York

Pandemic Influenza Control at the Border of Island Countries and in Households, Michael Baker, MD, University of Otago, New Zealand

Evaluation of Masks as a Source Control Non-Pharmaceutical Intervention, Donald Milton, MD, PhD, University of Massachusetts, Lowell

Cetron said the CDC has had requests from state and local public health agencies and other groups for specific guidelines on community prevention measures. The current federal pandemic flu plan contains some general information on the topic, but groups have asked for more details, he said.

"We've been engaging for the last several months in responding to that need for greater specificity," Cetron said. "We've been working with many external partners and stakeholders to come up with more refined guidance for community preparedness. We hope to have an interim document by the end of the year."

When available, the findings of the studies announced yesterday will be used to help refine the guidelines, he said. Other plans include "a series of public engagement projects around the country over the next months." In addition, the CDC has asked the Institute of Medicine to assess community prevention measures by examining mathematical modeling studies and historical evidence.

"The science base used to formulate some of these policies [on nonpharmaceutical control measures] is thin," Cetron said. "We're trying to develop a new evidence and science base. . . . This is an ongoing process that will continue to be informed by new studies."

The CDC has also engaged the Harvard University School of Public Health to gauge public opinion and knowledge on the topic. A group led by Dr. Robert Blendon is polling people about their ability or willingness to cooperate in prevention measures, such as by staying home from work when sick and finding child care if schools close.

"His group is actively working on this project now; we expect to have some results in a couple of weeks," Cetron said.